Encephale
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Selective serotonin reuptake inhibitors (SSRIs) are the most prescribed antidepressant treatment for treat major depressive disorders. Despite their effectiveness, only 30% of SSRI-treated patients reach remission of depressive symptoms. SSRIs by inhibiting the serotonin transporter present some limits with residual symptoms. ⋯ However, these combinations cannot constitute first line of treatment considering the observed increase of side effects. Such an approach should be adapted to each patient in regard to its particular symptoms as well as clinical history. The next generation of antidepressant therapy will need to take into consideration the interconnections and the interrelation between the monoaminergic systems.
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The Big Five Inventory (BFI) developed by John et al. (1991) is one of the most widely accepted tools for assessing dimensions of personality. It comprises 44 items that assess five broad dimensions of personality (the Big Five Factors): Extraversion, Agreeableness, Conscientiousness, Neuroticism and Openness to experience. Based on correlations with the facets described in the NEO Personality Inventory Revised (NEO PI-R), another Big Five assessment tool with 240 items and 6 facets per dimension, Soto and John (2009) showed that the dimensions in the BFI could be divided into two facets each (ten facets altogether). These results are in line with those of DeYoung et al. (2007), who ran factorial analyses with all the NEO PI-R facets and the International Personality Item Pool (IPIP) and identified ten intermediate factors (between facets and dimensions) which they called "aspects" (two per dimension). The goal of the present study is to investigate the ten facets described by Soto and John in a French sample, using the French version of the BFI (BFI-Fr), which has good psychometric properties, and to check whether the pattern of correlations of these facets with the NEO PI-R match those of the American version. ⋯ We showed that the BFI-Fr can be used to assess nine of the ten facets described by Soto and John. We also identified an Emotional Instability facet, replacing the Depression facet of Neuroticism. DeYoung et al. (2007) considered that anxiety and depression are indissociable and can be represented by a Neuroticism aspect they labeled Withdrawal. They suggested a second aspect of this dimension they called Volatility (with the N2 Angry Hostility facet of the NEO PI-R as main marker and the N5 Impulsiveness and N3 Depression as secondary markers). The Emotional Instability facet we found corresponds closely to the N2 Angry Hostility facet of the NEO PI-R and appears to be a satisfactory marker of DeYoung et al.'s (2007) Volatility aspect. Although this study has limitations, particularly related to the samples (students), the BFI-Fr facets (derived from those defined by Soto and John in the BFI or proposed as improvements on the original facets) match the corresponding NEO PI-R facets and can also be seen as main markers of the aspects defined by DeYoung et al.
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The pregnancy periods of peripartum and immediate postpartum represent moments of opportunity to access care. Both prevention and therapeutic management can be offered with a better chance of success during these periods. Our specific Consultation Liaison (CL) team PPUMMA was created in order to respond to the need for early detection of psychopathology and rapid implementation of therapeutic management and preventive measure for mother and child. The importance of urgently intervening "on site" seemed a necessity since duration of hospitalization in maternity wards is very short. Women might not know or understand their symptoms or be ready to ask for a referral for themselves but could be ready to respond positively to a team approach where the psychiatrist is part of the Ob-Gyn department. Working with an interdisciplinary approach tends to lower stress linked to the psychiatric side of the consultation and stigma related to psychological or psychiatric issues; therefore, PPUMMA intervenes within 48 to 72hours of birth. It deals with assessment and diagnosis during the peripartum period and orientation and referral for both mother and infant when necessary after birth. The Perinatal Psychiatry emergency mobile unit PPUMMA was created in order to address these issues. ⋯ The number of referrals and diagnostic criteria met show how essential a psychiatric CL team assessing and orienting women during pregnancy and immediate postpartum is. Opportunity for adaptation of treatment during the peripartum period and more long-term tailored management of disorders can be organized during this period in a multidisciplinary approach. Knowing how essential maternal mental health is for women, for infant development and for mother-infant interactions, this is a unique window for access to care and intervention. Maternal mental health is a public health issue. Access to psychiatric assessment and care during the peripartum period offers unique possibilities for prevention and care.